Medical conditions that dysregulate acetylcholine receptors

ADDITIONAL TAGS:

Medical conditions that dysregulate acetylcholine receptors

Disorder-Acetylcholine Receptors-Comments / Notes

Stroke-Up-regulation-Succinylcholine may cause hyperkalemia months after the stroke Recovery of neuromuscular function to pre-burn level may take months to years.

Burns-Up-regulation-Do not use after 24-48 hours.

Prolonged Immobility-Up-regulation-Be cautious; no guidelines on minimal time patient has to be immobile before having hyperkalemic response Risk of reaction increases significantly after 16 days Careful: especially if flaccidity. spasticity or hyperreflexia May show resistance or sensitivity function: twitch monitor may not be accurate depending on site If using NDMR give small doses and monitor neuromuscular (orbicularis oculi underestimates muscle paralysis).

Multiple Sclerosis-Up-regulation-High risk for hyperkalemia.

Amyotrophic lateral sclerosis (ALS) Guillain-Barre-Up-regulation-Contraindicated.

Muscular Dystrophies (MD): Duchenne/Becker-Sensitive-Risk of hyperkalemia may persist after symptomatic recovery May be normal or sensitive due to muscle wasting and decreased contractile force Food and Drug Administration (FDA) warning against the use of succinylcholine in pediatric patients due to potential undiagnosed MD and hyperkalemic arrest.

Myasthenia Gravis-Down-regulation-Resistant.

Disorder of prejunctional Ca auto-Ab-Lambert-Eaton syndrome-Sensitive-Sensitive.

Anticholinesterase poisoning-Down-regulation-Prolonged response Succinylcholine should be avoided as it is degraded by plasma cholinesterase - may result in prolonged paralysis: neostigmine should be avoided since it will worsen the primary problem.

Organophosphate poisoning-Down-regulation-